More than 80 percent of the nation’s large employers are moving to a “carrot or stick” approach to coax their employees to better health with the number likely to rise thanks to the Affordable Care Act, according to the MidwestBusiness Group on Health.

The threat of a penalty or the promise of a reward is a growing incentive strategy used by 82 percent of nearly 100 global and national employers that are lowering premiums and offering gift cards for good health or charging higher co-payments and surcharges for poor health choices like smoking, according to the MidwestBusiness Group on Health.

There were 40 percent in the survey using incentives, or rewards, like gift cards, merchandise or a reduction on what the worker pays out of his or her paycheck. Nearly 7 percent used disincentives, or penalties, such as increasing the worker’s share of total company-paid premiums or making the worker pay higher deductibles or out-of-pocket costs. Smokers were by far the most commonly penalized workers. Meanwhile, 37 percent of those employers surveyed used both, a mix of rewards and penalties in an effort to improve health outcomes.